RADIOGRAPHIC POSITIONING

-ABDOMEN-
11.01.2022

Ang Ee May
College of Health Sciences
UMMC
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 OVERVIEW
1. Patient preparation.
2. Positioning considerations.
3. Radiation protection.
4. Exposure factors.
5. Positioning techniques.
6. Acute abdominal series.

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PATIENT PREPARATION

• Remove all clothing

and any opaque
objects in the area to
be radiographed.

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 GENERAL POSITIONING
CONSIDERATIONS

• Make patients as comfortable as

possible on the radiographic table.
• A pillow under the head and support
under the knees will enhance comfort
for a supine abdomen.
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BREATHING INSTRUCTIONS
• Motion may result from:
– voluntary movement –breathing.
– involuntary – peristaltic action of the
bowel .
• To minimize radiographic unsharpness due
to motion:
– careful breathing instruction (suspended
expiration)– voluntary movement.
– shortest exposure time possible –
involuntary movement.
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 IMAGE MARKERS

• Patient ID &
information – should
be clear and legible.
• Lead markers
– L or R,
– ‘up side’ markers
(arrows or ball
bearings).

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RADIATION PROTECTION
1. Gonadal shielding:
– Should be used for males.
– Females – should be used only when
such shields do not obscure essential
anatomy.
2. Pregnancy protection – 10 day / LMP rule.
3. Collimation:
– Small patient – collimate to skin
borders.
– Large patient – collimate according to
image receptor (IR) size (35 x 43 cm).
4. Avoid repeat exposures – ALARA.
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RADIATION PROTECTION

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 EXPOSURE FACTORS

Type Exposure
1 Normal/Medium Size 70-80 kV
Patient 30-40 mAs

2 TRO free intraperitoneal Slight decrease

air
3 TRO fluids or solid mass Increase

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 TOPOGRAPHIC LANDMARKS
1. Xiphoid Tip (T9-
T10)
2. Lower Costal
Margin (L2-L3)
3. Iliac Crest (L3-L4)
4. Anterior Superior
Iliac Spine
5. Greater
Trochanter
6. Symphysis Pubis
7. Ischial Tuberosity
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BASIC & SPECIAL PROJECTIONS
1. Basic abdomen - AP Supine (KUB).
2. Special abdomen projections:
i. PA prone.
ii. Erect AP.
iii. Lateral decubitus (AP).
iv. Dorsal decubitus (lateral).
v. Lateral.
3. Acute Abdomen – three way series.
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 1. AP SUPINE /KUB
Patient position:
• Supine with midsagittal plane (MSP)
centered to midline of table and IR.
• Arms at patient’s sides, away from body.
• Legs extended with support under knees.

Part position:
• Center of cassette to level of iliac crests with
lower border at symphysis pubis.
• ASISs and both shoulders are the same
distance from table top – no rotation.
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 1. AP SUPINE /KUB
Central Ray:
• CR perpendicular to and directed to MSP at
the level of iliac crest (center of IR).
• Minimum source-image-distance (SID) of
100 cm. (40 inches).

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1. AP SUPINE /KUB

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 2(i). PA PRONE
Patient position:
• Prone with MSP centered to midline of
table and IR.
• Arms up beside head.
• Legs extended with support under ankles.

Part position:
• Center of IR to level of iliac crests with
lower border at symphysis pubis.
• No rotation pelvis and both shoulders.

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 2(i). PA PRONE
Central Ray:
• CR perpendicular to and directed to MSP
at the level of iliac crest (center of IR).
• Minimum source-image-distance (SID) of
100 cm. (40 inches).

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2(i). PA PRONE

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 RADIOGRAPHIC CRITERIA
AP Supine & PA Prone
1. Structures shown. Outline of liver, spleen, kidneys,
air filled stomach and bowel segments and the arch
of symphysis pubis.
2. Position. No rotation: iliac wings, obturator
foramina(if visible) and ischial spine appear
symmetric; outer lower rib margins are the same
distance from spine.
3. Exposure. Sufficient exposure (mAs) Long scale
contrast (kV) visualize psoas muscle outline,
lumbar tranverse process and ribs. Margins of liver
and kidneys should be visible on smaller to
average-sized patients. No motion: ribs and all gas
bubble margin appear sharp.
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 2(ii). AP ERECT
Patient position:
• Standing/sitting erect, legs slightly spread,
back against table/IR or grid device.
• Patient should be upright at least 5 minutes
before exposure for visualizing small amounts
of free intraperitoneal air.
• MSP centered to midline of erect bucky and IR.
• Arms at sides away from body.
Part position:
• ASISs and both shoulders are the same
distance from table top – no rotation.
• Center of IR to level of 2 inches (5cm) above
iliac crests with upper border at the level of
axilla.
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 2(ii). AP ERECT
Central Ray:
• CR horizontal to
center of IR and
directed to MSP at
the level of 2 inches
(5cm) above iliac
crest.
• Minimum source-
image-distance (SID)
of 100 cm. (40
inches).

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2(ii). AP ERECT

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 2(iii). LATERAL DECUBITUS (AP)
Patient position:
• Lateral recumbent on radiolucent pad, firmly
against table or vertical grid device. Patient on
firm surface to prevent sagging and anatomy
cutoff.
• Knees partially flexed, one on top of another to
stabilize patient.
• Arms up near head.
• Patient should be on side at least 5 minutes
before exposure to allow air to rise or abnormal
fluids to accumulate.
• Left lateral decubitus best visualizes free
intraperitoneal air in the area of the liver in the
right upper abdomen away from the gastric
bubble. 22
 2(iii). LATERAL DECUBITUS (AP)
Part position:
• Center of IR to level of 2 inches (5cm)
above iliac crests with upper border at
the level of axilla (to include diaphragm).
• No rotation of pelvis and both shoulders
– patient’s body 90° to table / trolley.
• Adjust height of IR to center MSP of
patient to center of IR, but ensure that
upside of abdomen is clearly included on
the IR.

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 2(iii). LATERAL DECUBITUS (AP)
Central ray:
• CR horizontal, directed to center of IR, 2
inches (5 cm) above iliac crest.
• SID 100 cm.

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2(iii). LATERAL DECUBITUS
(AP)

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 RADIOGRAPHIC CRITERIA
Erect & Lateral Decubitus
1. Structures shown – air-filled stomach &
loops of bowel and air-fluid levels where
present. Should include bilateral
diaphragm & as much of lower abdomen
as possible.

2. Position. No rotation: iliac wings appear

symmetric; outer lower rib margins are
the same distance from spine. Spine
should be straight (unless scoliosis is
present) & align to center of IR.
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 RADIOGRAPHIC CRITERIA
Erect & Lateral Decubitus

3. Exposure.
– No motion: ribs and all gas bubble
margin appear sharp.
– Exposure sufficient to visualize spine,
ribs & soft tissue but not to overexpose
possible intraperitoneal air in upper
abdomen.
– Slightly less overall density than supine
abdomen.

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2(iv). DORSAL DECUBITUS (LATERAL)
Patient position:
• Patient supine on radiolucent pad, side
against vertical grid device.
• Pillow under head, arms up beside head,
support under partially flexed knees may
be more comfortable for the patient.

Part position:
• Adjust patient so that center of IR and CR
is 2 inches above level of iliac crest (to
include diaphragm).
• ASISs and both shoulders are the same
distance from table top – no rotation.
• Adjust height of IR to align midcoronal
plane to centerline of IR.
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 2(iv). DORSAL DECUBITUS
(LATERAL)
Central ray:
• CR horizontal, directed to center of
IR, 2 inches (5 cm) above iliac crest
and to midcoronal plane.
• SID 100 cm.

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2(iv). DORSAL DECUBITUS
(LATERAL)

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 2(v). LATERAL
Patient position:
• Patient in lateral recumbent position on
right or left side.
• Elbows flexed, arms up, knees and hips
partially flexed, pillow between knees to
maintain a lateral position.

Part position:
• Align midcoronal plane to CR and midline
of table
• Pelvis and thorax in true lateral position –
90° to table. 31
 2(v). LATERAL
Central ray
• CR perpendicular to table, centered 2
inches above above level of iliac
crest.
• IR centered to CR.

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2(v). LATERAL

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 RADIOGRAPHIC CRITERIA
Dorsal Decubitus & Lateral
1. Structures shown – Diaphragm & as
much of lower abdomen as possible
should be included. Air filled loops of
bowel in abdomen with soft tissue detail
should be visible in prevertebral &
anterior abdomen regions.
2. Position. No rotation as evident by
superimposition of posterior ribs &
posterior borders of iliac wings and
bilateral and bilateral ASISs.
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 RADIOGRAPHIC CRITERIA
Dorsal Decubitus & Lateral
3. Exposure.

• No motion: ribs and all gas bubble

margin appear sharp.

• Lumbar vertebrae may appear about

50% underexposed with soft tissue detail
visible in anterior abdomen & in
prevertebral region of lower lumbar
vertebra.

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 3. ACUTE ABDOMINAL
1.
SERIES
Specific clinical indications:
i. Bowel obstruction.
ii. Ascites.
iii. Perforated hollow viscus.
iv. Intraabdominal mass.
v. Post-op.
2. Three way abdomen:
i. AP Supine
ii. Erect (or Left Lateral Decubitus)
iii. PA Chest
*remember to take erect images first if patient
comes to the dept in an erect position.
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THE END

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